Search

Resumo Objetivo Identificar as potencialidades e fragilidades envolvidas na aplicabilidade da teleconsulta de enfermagem à pessoa idosa na Atenção Primária à Saúde durante a pandemia. Método Estudo qualitativo, do tipo exploratório-descritivo, realizado de março a abril de 2022, com 30 enfermeiros atuantes na Atenção Primária do município de Florianópolis, em Santa Catarina, Brasil. Os dados foram coletados mediante entrevistas individuais semiestruturadas e analisados por meio de Análise Temática de Minayo, seguindo três etapas: pré-análise, exploração do material, tratamento dos resultados obtidos e interpretação; com uso de análise indutiva. Resultados Dentre as potencialidades da teleconsulta de enfermagem destacam-se: ampliação do acesso aos serviços de saúde, continuidade do cuidado e proteção ao idoso durante período pandêmico e possibilidade de levar o atendimento para além de barreiras geográficas. As fragilidades envolveram dificuldades com o uso dos meios tecnológicos por parte dos idosos, falhas no processo de comunicação e a necessidade da presença do familiar ou cuidador no momento da teleconsulta. Conclusão A teleconsulta em enfermagem é uma tecnologia já utilizada em diversos países que ganhou visibilidade no Brasil diante do advento da pandemia provocada pelo coronavírus e se tornou um importante recurso de ampliação do acesso, continuidade do cuidado e manutenção do vínculo entre a equipe de saúde da família com as pessoas idosas e seus familiares. Todavia, essa tecnologia ainda necessita de melhor aperfeiçoamento para superar as dificuldades vivenciadas em sua utilização tanto por usuários quanto por profissionais.

Abstract Background Current regulatory discussions about microplastics are often questioned based on a lack of data indicating high ecotoxic hazards of these particles within standard and recognized definitions. Moreover, there is scientific debate on what metrics to report the micro-nanoplastics toxicity (i.e. mass or particle counts-based exposure). We present here the high potential sensitivity of three genotypically different clones of the European Daphnia longispina species complex exposed to non-functionalized polystyrene nanobeads of 50 nm and 100 nm in diameter according to adapted OECD 202 test protocol. Results EC50s 48 h varied from 0.2 to 8.9 mg L−1 (mean 2.49 mg L−1) for 50 nm beads, and from 32.7 to 90.3 mg L−1 (mean 59.39 mg L−1) for the 100 nm. EC10s 48 h varied from 0.0007 to 7.5 mg L−1 (mean 0.28 mg L−1) for 50 nm beads, and from 25.5 to 69.1 mg L−1 (mean 47.51 mg L−1) for the 100 nm. Inter-clonal variability was about tenfold. Therefore, several 1000 s-fold variations in mass-based ecotoxicity for these polystyrene beads was observed if particle size and Daphnia genotype are considered jointly. Conclusions Such ecotoxicity potential is comparable to highly toxic chemicals in global and EU-based regulatory classification and labelling. Ecotoxicity based on particle counts suggested convergence of EC50s, with effects generally observed around 1011 to1015 particles L−1. The present results highlight the potential high hazard of these particles and the relevance of particle size and exposure metrics on hazard conclusion. Graphical Abstract

Computational experiments have been very important to numerically simulate real phenomena in several areas. Many studies in computational biology discuss the necessity to obtain numerical replicability to accomplish new investigations. However, even following well-established rules in the literature, numerical replicability is unsuccessful when it takes the computer's limitations for representing real numbers into consideration. In this study, we used a previous published recurrent network model composed by Hodgkin-Huxley-type neurons to simulate the neural activity during development. The original source code in C/C++ was carefully refactored to mitigate the lack of replicability; moreover, it was re-implemented to other programming languages/software (XPP/XPPAUT, Python and Matlab) and executed under two operating systems (Windows and Linux). The commutation and association of the input current values during the summation of the pre-synaptic activity were also analyzed. A total of 72 simulations which must obtain the same result were executed to cover these scenarios. The results were replicated when the high floating-point precision (supplied by third-party libraries) was used. However, using the default floating-point precision type, none of the results were replicated when compared with previous results. Several new procedures were proposed during the source code refactorization; they allowed replicating only a few scenarios, regardless of the language and operating system. Thus, the generated computational “errors” were the same. Even using a simple computational model, the numerical replicability was very difficult to be achieved, requiring people with computational expertise to be performed. After all, the research community must be aware that conducting analyses with numerical simulations that use real number operations can lead to different conclusions.

Synovial sarcoma (SS) is a rare malignant mesenchymal tumor that mainly occurs in body extremities, being uncommon in the head and neck region. In the present study, we described a case of primary intraosseous SS arising in the mandible of a 22-year-old young male. The patient reported a painful swelling on the left side of the mandible for the last 7 months. Imaging exams showed the presence of an expansive and multilocular radiolucent lesion, extending from the left condyle to the mandibular body. The clinic diagnostic hypotheses were ameloblastoma or malignant neoplasm. Histologically, the lesion was characterized by a proliferation of spindle cells exhibiting vesicular nuclei and evident nucleolus. Neoplastic cells were positive for AE1/AE3, cytokeratin 7, vimentin, CD-99, and TLE-1 and negative for CD-34, S-100, SMA, and HHF-35. A combination of clinical, histologic, and immunohistochemical characteristics supported the diagnosis of SS. The patient was referred for treatment, and preoperative exams did not reveal any other tumor foci in the body of the patient. The final diagnosis was of a primary intraosseous SS of the mandible.

ABSTRACT Objective: To develop and apply educational gerontotechnology through the articulation of playfulness, aimed at promoting the health of the elderly undergoing haemodialysis. Method: Convergent Care Research, following phases: conception, research structure (problem, objective and literature review); instrumentation, involving decisions about delimitation/detailing of the location (haemodialysis clinic), participants (ten elderly patients on haemodialysis), data collection instruments (semi-structured interview, participant observation and documentary/medical analysis); screening, rigorous investigation of haemodialysis treatment and analysis, guided by apprehension, synthesis, theorization and transfer. Results: Health needs of emerging elderly: Complications and worsening of chronic kidney disease; Self-care; Empowerment; Deficit of activities; Health promotion and Nursing care; and Importance of the family. Gerontotechnology developed: Game of Attitudes; its application aroused feelings - overcoming, occupation and knowledge. Final considerations: Game of attitudes makes it possible to remodel the care of the elderly undergoing haemodialysis; it is a tool that enriches the practice, allows innovation, aiding in the success of the treatment.

Propomos uma heurística que define as regras para uma cooperação eficiente de um sistema multirrobô, empregado para a resolução de tarefas em um ambiente controlado. Essa heurística possibilita que um grupo de robôs tenha melhor desempenho na resolução de uma lista de tarefas sem a intervenção de algum agente externo ao ambiente. Por meio das regras definidas para as trocas de experiências, o ambiente obteve ganho de conhecimento, melhor utilização dos robôs e redução no tempo de execução das tarefas.

A teoria Gaia foi divulgada no início da década de 1970 pelo cientista inglês James Lovelock. Esta teoria propõe um sistema cibernético que mantêm o ambiente físico-químico da Terra sempre em ótimas condições para a existência de vida no planeta. Atualmente este sistema está em desequilíbrio e o homem é, sem dúvida, a causa para isso. Como conseqüências estão acontecendo fenômenos fora da normalidade em todo o planeta, e um desses fenômenos é o conhecido aquecimento global. Neste artigo, analisamos como o aquecimento global e a teoria Gaia estão associados e ainda propomos a utilização destes dois assuntos como parte integrante do processo de educação e ensino de ciências. A partir disso concluímos que esses dois temas têm uma importante contribuição para ajudar a entender os problemas ambientais atuais.

Abstract Background In order to identify rice genes involved in nutrient partitioning, microarray experiments have been done to quantify genomic scale gene expression. Genes involved in nutrient partitioning, specifically grain filling, will be used to identify other co-regulated genes, and DNA binding proteins. Proper identification of the initial set of bait genes used for further investigation is critical. Hierarchical clustering is useful for grouping genes with similar expression profiles, but decreases in utility as data complexity and systematic noise increases. Also, its rigid classification of genes is not consistent with our belief that some genes exhibit multifaceted, context dependent regulation. Results Singular value decomposition (SVD) of microarray data was investigated as a method to complement current techniques for gene expression pattern recognition. SVD's usefulness, in finding likely participants in grain filling, was measured by comparison with results obtained previously via clustering. 84 percent of these known grain-filling genes were re-identified after detailed SVD analysis. An additional set of 28 genes exhibited a stronger grain-filling pattern than those grain-filling genes that were unselected. They also had upstream sequence containing motifs over-represented among grain filling genes. Conclusions The pattern-based perspective that SVD provides complements to widely used clustering methods. The singular vectors provide information about patterns that exist in the data. Other aspects of the decomposition indicate the extent to which a gene exhibits a pattern similar to those provided by the singular vectors. Thus, once a set of interesting patterns has been identified, genes can be ranked by their relationship with said patterns.

Background: Soft tissue sarcoma (STS) is one of the most frequently diagnosed cancers among men younger than age 30 years and a leading cause of cancer death in men younger than age 40 years. The military may be more exposed to STS risk factors and have generally better health and health care access than the general population, which may relate to lower cancer risk and/or early detection. This study compared STS incidence between servicemen and men in the general U.S., Methods: Data were from the Department of Defense's Automated Central Tumor Registry (ACTUR) and the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program. Subjects were active-duty servicemen in ACTUR and men in SEER aged 18-59 years diagnosed with STS from 1990 to 2013. Age-adjusted rates, incidence rate ratios (IRR), and 95% CIs were calculated., Results: STS incidence rates were lower in ACTUR than SEER overall (IRR = 0.86 [0.78-0.93]), for 18- to 39-year-old men (IRR = 0.78 [0.70-0.86]), by race (White: IRR = 0.85 [0.77-0.95]; Black: IRR = 0.77 [0.63-0.94]), for sites other than skin/connective/soft tissue (IRR = 0.49 [0.37-0.63]), other specified histologies (IRR = 0.84 [0.71-0.98]), and unspecified histology (IRR = 0.57 [0.38-0.82]). Rates were lower in ACTUR for regional (IRR = 0.37 [0.28-0.47]) and distant metastases (IRR = 0.58 [0.43-0.76]), even when race and age stratified. However, rates were higher in ACTUR for 40- to 59-year-old men (IRR = 1.25 [1.04-1.48]) and localized tumors (IRR = 1.16 [1.04-1.29])., Conclusion: Lower STS rates among servicemen may relate to better health and early detection and treatment of STS-associated conditions within the military health system, which provides universal care. Higher rates among 40- to 59-year-old servicemen may result from greater cumulative military-related exposures., (© 2024 American Cancer Society.)

Background: Respiratory syncytial virus (RSV) is a leading cause of lower respiratory tract disease among infants and young children worldwide, especially in low- and middle-income countries (LMICs). RSM01 is a novel, highly potent, half-life-extended anti-RSV monoclonal antibody (mAb) candidate primarily being developed for LMICs. Here we present the preclinical characterisation and results of a phase 1 trial of RSM01., Methods: Preclinical characterisation of RSM01 was conducted using in-vitro neutralization assays and cotton rat models. In the first-in-human, double-blind, phase 1 trial, 56 healthy adults were randomised 6:1 within dose cohorts to receive a single dose of RSM01 (n = 48) or placebo (n = 8): 300 mg intravenously (IV), 300 mg intramuscularly (IM) or 1000 mg IV (parallel cohorts), 3000 mg IV, and an expansion cohort of 600 mg IM. Systemic solicited adverse events (AEs) were assessed through day 7; unsolicited AEs were collected through day 151. Pharmacokinetics and anti-drug antibodies (ADA) to RSM01 were assessed using immunoassays. A population pharmacokinetics model predicted paediatric pharmacokinetics parameters using allometric scaling and age-specific population weight statistics of North American and African infants., Results: RSM01 exhibited highly potent neutralizing activity in the single ng/mL range (0.7-6.4) against diverse RSV-A and RSV-B isolates in vitro. RSM01 also demonstrated prophylactic efficacy in cotton rat models with both RSV subtypes. In the phase 1 clinical trial, the most common unsolicited AEs were COVID-19 (2/48), headache (2/48), and nausea (2/48), all in RSM01-treated participants. The only systemic solicited AEs reported were headache (5/48) and tiredness (2/48) in participants receiving RSM01. No serious AEs or deaths were reported. The half-life of RSM01 was 78 days with dose-proportional increases in T max and AUC last after IV administration. Among RSM01-treated participants, 2/48 were ADA positive at baseline, and 1/48 seroconverted to ADA-positive post-baseline., Conclusions: RSM01 is a highly potent, half-life-extended, RSV-neutralising mAb candidate that was shown to be well tolerated in healthy adults. The rate of ADA to RSM01 was low. The long half-life of RSM01 and pharmacokinetics profile support further development of RSM01 as a potential single dose per season prophylaxis to prevent RSV disease in infants., Trial Registration: Clinicaltrials.gov NCT05118386, Nov 12, 2021., Competing Interests: Declarations. Ethics approval and consent to participate: All animal experiments were performed under approval of Sigmovir's Institutional Animal Care and Use Committee. The clinical trial was conducted in accordance with the principles of the Declaration of Helsinki, and Good Clinical Practice guidelines of the ICH, and all applicable sections of the US CFR, 21 CFR Parts 50, 56, and 312. The trial protocol was approved by IRB of AdvarraTM (Columbia, MD, US). All participants provided written informed consent. This trial was registered with Clinical Trials.gov NCT05118386. Consent for publication: Not applicable. Competing interests: ABo, ML, SW, ABA, JTW, MS, and MWD are employees of Bill & Melinda Gates Medical Research Institute; DT is a former employee of PPD Inc and received funding to PPD Inc from Bill & Melinda Gates Medical Research Institute, DT is currently an employee of Boehringer Ingelheim and reports stocks/bonds from Sanara Medtech Inc; LMS and JA are former employees of Bill & Melinda Gates Medical Research Institute; HR and ABa are former employees of Arsanis Biosciences and report stocks/bonds from X4 Pharmaceuticals; AR is an employee of intiGROWTH LLC and received funding to intiGROWTH LLC from Bill & Melinda Gates Medical Research Institute; JT is employed by University Medical Centre Utrecht and received funding to University Medical Centre Utrecht from Bill & Melinda Gates Medical Research Institute., (© 2024. The Author(s).)

Background: Fellowship-trained orthopaedic oncologists in the US military provide routine clinical care and also must maintain readiness to provide combat casualty care. However, low oncologic procedure volume may hinder the ability of these surgeons to maintain relevant surgical expertise. Other low-volume specialties within the Military Health System (MHS) have established partnerships with neighboring civilian centers to increase procedure volume, but the need for similar partnerships for orthopaedic oncologists has not been examined. The purpose of this study was to characterize the practice patterns of US military fellowship-trained orthopaedic oncologists., Questions/purposes: We asked the following questions: (1) What are the diagnoses treated by US military fellowship-trained orthopaedic oncologists? (2) What are the procedures performed by US military fellowship-trained orthopaedic oncologists?, Methods: We queried the Military Data Repository, a centralized repository for healthcare data for all healthcare beneficiaries (active duty, dependents, and retirees) within the Defense Health Agency using the MHS's Management and Reporting Tool for all international common procedure taxonomy (CPT) codes and ICD-9 and ICD-10 codes associated with National Provider Identifier (NPI) numbers of active duty, military fellowship-trained orthopaedic oncologists. Fellowship-trained orthopaedic oncologists were identified by military specialty leaders. Then, we identified all procedures performed by the orthopaedic oncologist based on NPI numbers for fiscal years 2013 to 2022. We stratified the CPT codes by top orthopaedic procedure categories (such as amputation [performed for oncologic and nononcologic reasons], fracture, arthroplasty, oncologic) based on associated ICD codes. These were then tabulated by the most common diagnoses treated., Results: Thirteen percent (796 of 5996) of the diagnoses were oncologic, of which 45% (357 of 796) were malignant. Forty-four percent (158 of 357) of the malignancies were primary and 56% (199 of 357) were secondary; this translates to an average of 2 patients with primary and 2.5 patients with secondary malignancies treated per surgeon per year. During the study period, nine orthopaedic oncologists performed 5996 orthopaedic procedures, or 74 procedures per surgeon per year. Twenty-one percent (1252 of 5996) of the procedures were oncologic; the remaining procedures included 897 arthroplasties, 502 fracture-related, 275 amputations for a nononcologic indication, 204 infections, 142 arthroscopic, and 2724 other procedures., Conclusion: Although military orthopaedic oncologists possess expert skills that are directly translatable to combat casualty care and operational readiness, within MHS hospitals they treat relatively few patients with oncologic diagnoses, and less than one-half of those involve malignancies., Clinical Relevance: Despite postgraduation procedure volume raining stable over the last decade, it is unknown how many new patient visits for oncologic diagnoses and how many corresponding tumor procedures are necessary to maintain competence or build confidence after musculoskeletal oncology fellowship training. It is important to note that there are no military orthopaedic oncology fellowships, and all active duty orthopaedic oncologists undergo training at civilian institutions. Military-civilian partnerships with high-volume cancer centers may enable military orthopaedic oncologists to work at civilian cancer centers to increase their oncologic volume to ensure sustainment of operationally relevant knowledge, skills, and abilities and improve patient care and outcomes., Competing Interests: All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request., (Copyright © 2024 by the Association of Bone and Joint Surgeons.)

» The purpose of this article was to review the multidisciplinary, team-based approach necessary for the optimal management of patients with limb loss undergoing osseointegration surgery.» In this study, we describe the interdisciplinary process of screening, counseling, and surgical and rehabilitation considerations with an emphasis on principles rather than specific implants or techniques.» Integrated perioperative management and long-term surveillance are crucial to ensure the best possible outcomes.» We hope this model will service as an implant-agnostic guide to others seeking to development an osseointegration center of excellence., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSREV/B115)., (Copyright © 2024 Written work prepared by employees of the Federal Government as part of their official duties is, under the U.S. Copyright Act, a “work of the United States Government” for which copyright protection under Title 17 of the United States Code is not available. As such, copyright does not extend to the contributions of employees of the Federal Government.)

Background: Access to care is associated with cancer survival. The US Military Health System (MHS) provides universal health care to all beneficiaries. However, it is unknown whether survival among patients with bone sarcoma in a health system providing universal care is better than that in the general population. The aim of the study was to compare survival of patients with bone sarcoma in the US MHS with that of the US general population., Methods: The MHS data were obtained from the Department of Defense Automated Central Tumor Registry (ACTUR). The US general population data were obtained from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) registry. Adult patients were defined as those aged 25 years or older with a histologically confirmed musculoskeletal bone sarcoma diagnosed from January 1, 1987, to December 31, 2013. Kaplan-Meier survival curves and multivariable Cox proportional hazards models were used to compare the overall survival of the two populations., Results: The final analysis included 2,273 bone sarcoma cases from ACTUR and 9,092 bone sarcoma cases from SEER. ACTUR patients had significant lower 5-year all-cause death (hazard ratio = 0.72; 95% CI, 0.66 to 0.78) after adjustment for the potential confounders. ACTUR patients with bone sarcoma also exhibited significantly lower risk of all-cause death during the entire follow-up period than the SEER patients (hazard ratio = 0.75; 95% CI, 0.6 to 0.81)., Conclusions: MHS beneficiaries with bone sarcoma may have longer survival than SEER patients. Our findings support the role of universal access to high-quality care in improving bone sarcoma outcomes., Competing Interests: All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request., (Copyright © 2024 by the American Academy of Orthopaedic Surgeons.)

Summary: Pain after amputation is often managed by target muscle reinnervation (TMR) with the added benefit that TMR also provides improved myoelectric terminal device control. However, as TMR takes several months for the recipient muscles to reliably reinnervate, this technique does not address pain within the subacute postoperative period during which pain chronification, sensitization, and opioid dependence and misuse may occur. Cryoneurolysis, described herein, uses focused, extreme temperatures to essentially "freeze" the nerve, blocking nociception, and improving pain in treated nerves potentially reducing the chances of pain chronification, sensitization, and substance dependence or abuse., Competing Interests: The authors report no conflict of interest. The contents of this publication are the sole responsibility of the author(s) and do not necessarily reflect the views, opinions, or policies of Uniformed Services University of the Health Sciences (USUHS), The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., the Department of Defense (DoD) or the Departments of the Army, Navy, or Air Force. Mention of trade names, commercial products, or organizations does not imply endorsement by the US Government., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Importance: Periprosthetic joint infection (PJI) is a rare but devastating complication. Most patients undergoing total joint arthroplasty (TJA) also need routine screening colonoscopy, in which transient bacteremia may be a potential source for hematogenous PJI. Patients and surgeons must decide on an optimal time span or sequence for these 2 generally elective procedures, but no such guidelines currently exist., Objective: To evaluate associations of colonoscopy with the risk of post-TJA PJI for the development of clinical practice recommendations for colonoscopy screening in patients undergoing TJA., Design, Setting, and Participants: This retrospective cohort study of Military Health System (MHS) beneficiaries older than 45 years who underwent TJA from January 1, 2010, to December 31, 2016, used propensity score matching and logistic regression to evaluate associations of colonoscopy with PJI risk. Statistical analyses were conducted between January and October 2023., Exposure: Colonoscopy status was defined by Current Procedural Terminology code for diagnostic colonoscopy within 6 months before or 6 months after TJA., Main Outcomes and Measures: Periprosthetic joint infection status was defined by a PJI International Classification of Diseases code within 1 year after TJA and within 1 year from the post-TJA index colonoscopy date., Results: Analyses included 243 671 patients (mean [SD] age, 70.4 [10.0] years; 144 083 [59.1%] female) who underwent TJA in the MHS from 2010 to 2016. In the preoperative colonoscopy cohort, 325 patients (2.8%) had PJI within 1 year postoperatively. In the postoperative colonoscopy cohort, 138 patients (1.8%) had PJI within 1 year from the index colonoscopy date. In separate analyses of colonoscopy status within 6 months before and 6 months after TJA, younger age, male sex, and several chronic health conditions (diabetes, kidney disease, and pulmonary disease) were each associated with higher PJI risk. However, no association was found with PJI risk for perioperative colonoscopy preoperatively (adjusted odds ratio, 1.10; 95% CI, 0.98-1.23) or postoperatively (adjusted odds ratio, 0.90; 95% CI, 0.74-1.08)., Conclusions and Relevance: In this large retrospective cohort of patients undergoing TJA, perioperative screening colonoscopy was not associated with PJI and should not be delayed for periprocedural risk. However, health conditions were independently associated with PJI and should be medically optimized.

Importance: Gastrointestinal stromal tumor (GIST) is a rare cancer treated with the tyrosine kinase inhibitors imatinib mesylate or sunitinib malate. In general, in low- and middle-income countries (LMICs), access to these treatments is limited., Objective: To describe the demographic characteristics, treatment duration, and survival of patients with GIST in LMICs treated with imatinib and sunitinib through The Max Foundation programs., Design, Setting, and Participants: This retrospective database cohort analysis included patients in 2 access programs administered by The Max Foundation: the Glivec International Patient Assistance Program (GIPAP), from January 1, 2001, to December 31, 2016, and the Max Access Solutions (MAS) program, January 1, 2017, to October 12, 2020. Sixty-six countries in which The Max Foundation facilitates access to imatinib and sunitinib were included. Participants consisted of patients with approved indications for imatinib, including adjuvant therapy in high-risk GIST by pathologic evaluation of resected tumor or biopsy-proven unresectable or metastatic GIST. All patients were reported to have tumors positive for CD117(c-kit) by treating physicians. A total of 9866 patients received treatment for metastatic and/or unresectable disease; 2100 received adjuvant imatinib; 49 received imatinib from another source and were only included in the sunitinib analysis; and 53 received both imatinib and sunitinib through The Max Foundation programs. Data were analyzed from October 13, 2020, to January 30, 2024., Main Outcomes and Measures: Demographic and clinical information was reported by treating physicians. Kaplan-Meier analysis was used to estimate time to treatment discontinuation (TTD) and overall survival (OS). An imputation-based informed censoring model estimated events for patients lost to follow-up after treatment with adjuvant imatinib. Patients who were lost to follow-up with metastatic or unresectable disease were presumed deceased., Results: A total of 12 015 unique patients were included in the analysis (6890 male [57.6%]; median age, 54 [range, 0-100] years). Of these, 2100 patients were treated with imatinib in the adjuvant setting (median age, 54 [range 8-88] years) and 9866 were treated with imatinib for metastatic or unresectable disease (median age, 55 [range, 0-100] years). Male patients comprised 5867 of 9866 patients (59.5%) with metastatic or unresectable disease and 1023 of 2100 patients (48.7%) receiving adjuvant therapy. The median OS with imatinib for unresectable or metastatic disease was 5.8 (95% CI, 5.6-6.1) years, and the median TTD was 4.2 (95% CI, 4.1-4.4) years. The median OS with sunitinib for patients with metastatic or unresectable GIST was 2.0 (95% CI, 1.5-2.5) years; the median TTD was 1.5 (95% CI, 1.0-2.1) years. The 10-year OS rate in the adjuvant setting was 73.8% (95% CI, 67.2%-81.1%)., Conclusions and Relevance: In this cohort study of patients with GIST who were predominantly from LMICs and received orally administered therapy through the GIPAP or MAS programs, outcomes were similar to those observed in high-resource countries. These findings underscore the feasibility and relevance of administering oral anticancer therapy to a molecularly defined population in LMICs, addressing a critical gap in cancer care.

Background: There are limited data comparing the beach-chair (BC) versus lateral decubitus (LD) position for arthroscopic anterior shoulder stabilization., Purpose: To identify predictors of instability recurrence and revision after anterior shoulder stabilization and evaluate surgical position and glenoid bone loss as independent predictors of recurrence and revision at short- and midterm follow-ups., Study Design: Cohort study; Level of evidence, 3., Methods: A consecutive series of 641 arthroscopic anterior stabilization procedures were performed from 2005 to 2019. All shoulders were evaluated for glenohumeral bone loss on magnetic resonance imaging. The primary outcomes of interest were recurrence and revision. Multivariable logistic regression models were used to assess the relationships of outcomes with age, position, glenoid bone loss group, and track., Results: A total of 641 shoulders with a mean age of 22.3 years (SD, 4.45 years) underwent stabilization and were followed for a mean of 6 years. The overall 1-year recurrent instability rate was 3.3% (21/641) and the revision rate was 2.8% (18/641). At 1 year, recurrence was observed in 2.3% (11/487) and 6.5% (10/154) of BC and LD shoulders, respectively. The 5-year recurrence and revision rates were 15.7% (60/383) and 12.8% (49/383), respectively. At 5 years, recurrence was observed in 16.4% (48/293) and 13.3% (12/90) of BC and LD shoulders, respectively. Multivariable modeling demonstrated that surgical position was not associated with a risk of recurrence after 1 year (odds ratio [OR] for LD vs BC, 1.39; P = .56) and 5 years (OR for LD vs BC, 1.32; P = .43), although younger age at index surgery was associated with a higher risk of instability recurrence (OR, 1.73 per SD [4.1 years] decrease in age; P < .03). After 1 and 5 years, surgical position results were similar in a separate multivariable logistic regression model of revision surgery as the dependent variable, when adjusted for age, surgical position, bone loss group, and track. At 5 years, younger age was an independent risk factor for revision: OR 1.68 per SD (4.1 years) decrease in age ( P < .05)., Conclusion: Among fellowship-trained orthopaedic surgeons, there was no difference in rates of recurrence and revision surgery after performing arthroscopic anterior stabilization in either the BC or the LD position at 1- and 5-year follow-ups. In multivariable analysis, younger age, but not surgical position, was an independent risk factor for recurrence., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: B.G.Y. has received support for education from Southtech and Supreme Orthopedic Systems. A.B.A. has received support for education from Supreme Orthopedic Systems. D.J.T. has received support for education from Gemini Mountain Medical and Arthrex. L.E.L. has received support for education from Alpha Orthopedic Systems, Arthrex, and Supreme Orthopedic Systems and a grant from DJO. J.P.R. has received support for education from Supreme Orthopedic Systems and Stryker. B.D.O. has received consulting fees from Linvatec, DePuy Synthes, Vericel, Musculoskeletal Transplant Foundation, and Medical Device Business Services; royalties from Linvatec; and honoraria from Vericel; he is an associate editor for AJSM. M.D. has received support for education from Arthrex, SeaPearl, and Supreme Orthopedic Systems. J.F.D. has received support for education from Supreme Orthopedic Systems and compensation for services other than consulting from Arthrex. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Some of the most common human systemic diseases-both benign and malignant-affect bone regulation, formation, and homeostasis (the cellular balance regulated by osteocytes, osteoblasts, and osteoclasts). This review discusses our current understanding of the molecular components and mechanisms that are responsible for homeostasis and interactions resulting in dysregulation (dysfunction due to the loss of the dynamic equilibrium of bone homeostasis). Knowledge of key pathways in bone biology can improve surgeon understanding, clinical recognition, and treatment of bone homeostasis-related diseases., Competing Interests: Disclaimer: Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, or patent/licensing arrangements) that might pose a conflict of interest in connection with the submitted article., (Copyright © 2023 by the American Academy of Orthopaedic Surgeons.)

Competing Interests: The author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request.

Goldbeating is the ancient craft of thinning bulk gold (Au) into gossamer leaves. Pioneered by ancient Egyptian craftsmen, modern mechanized iterations of this technique can fabricate sheets as thin as ∼100 nm. We take inspiration from this millennia-old craft and adapt it to the nanoscale regime, using colloidally synthesized 0D/1D Au nanoparticles (AuNPs) as highly ductile and malleable nanoscopic Au ingots and subjecting them to solid-state, uniaxial compression. The applied stress induces anisotropic morphological transformation of AuNPs into 2D leaf form and elucidates insights into metal nanocrystal deformation at the extreme length scales. The induced 2D morphology is found to be dependent on the precursor 0D/1D NP morphology, size (0D nanosphere diameter and 1D nanorod diameter and length), and their on-substrate arrangement (e.g., interparticle separation and packing order) prior to compression. Overall, this versatile and generalizable solid-state compression technique enables new pathways to synthesize and investigate the anisotropic morphological transformation of arbitrary NPs and their resultant emergent phenomena., (© The Author(s) 2023. Published by Oxford University Press on behalf of National Academy of Sciences.)

Purpose: Anterior cruciate ligament tears and anterior cruciate ligament reconstruction (ACLR) are common in young athletes. The modifiable and non-modifiable factors contributing to ACLR failure and reoperation are incompletely understood. The purpose of this study was to determine ACLR failure rates in a physically high-demand population and identify the patient-specific risk factors, including prolonged time between diagnosis and surgical correction, that portend failure., Methods: A consecutive series of military service members with ACLR with and without concomitant procedures (meniscus [M] and/or cartilage [C]) done at military facilities between 2008 and 2011 was completed via the Military Health System Data Repository. This was a consecutive series of patients without a history of knee surgery for two years prior to the primary ACLR. Kaplan-Meier survival curves were estimated and evaluated with Wilcoxon test. Cox proportional hazard models calculated hazard ratios (HR) with 95% confidence intervals (95% CI) to identify demographic and surgical factors that influenced ACLR failure., Results: Of the 2735 primary ACLRs included in the study, 484/2,735 (18%) experienced ACLR failure within four years, including (261/2,735) (10%) undergoing revision ACLR and (224/2,735) (8%) due to medical separation. The factors that increased failure include Army Service (HR 2.19, 95% CI 1.67, 2.87), > 180 days from injury to ACLR (HR 1.550, 95% CI 1.157, 2.076), tobacco use (HR 1.429 95% CI 1.174, 1.738), and younger patient age (HR 1.024, 95% CI 1.004, 1.044)., Conclusion: The overall clinical failure rate of service members with ACLR is 17.7% with minimum four-year follow-up, where more patients are likely to fail due to revision surgery than medical separation. The cumulative probability of survival at 4 years was 78.5%. Smoking cessation and treating ACLR patients promptly are modifiable risk factors impacting either graft failure or medical separation., Level of Evidence: Level III., (© 2023. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

Density-dependent mechanisms and habitat use are important drivers of marine spatial distribution in complex ecosystems such as coral or rocky reefs. In the last decade, a few studies have assessed habitat use by reef fishes in nearshore and coastal environments along the Brazilian coast. Serranidae (groupers and sea basses) are regarded as excellent models for understanding habitat use patterns due to their diversity, long lifespan, wide distribution, morphological and functional diversity, and behavioural complexity. Their trophic position in the food web, from meso- to top-predators, grants them critical roles as top-down population controllers. Herein, we present the first assessment of habitat use by five sympatric Serranidae in a Brazilian oceanic island, Trindade. The model species selected for this assessment were the coney (Cephalopholis fulva), the rock hind (Epinephelus adscensionis), the greater soapfish (Rypticus saponaceus), the Creole-fish (Paranthias furcifer) and the hybrid between C. fulva and P. furcifer. Our findings revealed that the species showed specific associations with topographic characteristics related to shelter from predation, reproduction and feeding. Habitat use in Trindade was similar to that observed in nearshore coastal environments (where the hybrid is absent). The present work contributes to the knowledge of habitat use and niche partitioning among key species, which is a valuable tool to subsidize effective conservation initiatives such as designing marine protected areas focusing on the behaviour and habitat use of key ecological players., (© 2023 Fisheries Society of the British Isles.)

Study Design: Retrospective review (level of evidence III)., Objective: Surgical care patterns for lumbar disc herniation (LDH), a common musculoskeletal condition of high relevance to the Military Health System (MHS), have not been described or compared across the direct care and purchased care MHS components. This study aimed to describe surgery rates in MHS beneficiaries who were diagnosed with LDH in direct care versus purchased care and to evaluate characteristics associated with the location of surgery. Differences in care patterns for LDH may suggest unexpected variation within the centrally managed MHS., Methods: We described 1-year rates of surgery among beneficiaries who were diagnosed with LDH in direct care versus purchased care. Among beneficiaries who were diagnosed in direct care and had surgery, multivariable logistic regression models were used to identify characteristics associated with surgery location., Results: We identified 726,638 MHS beneficiaries who were diagnosed with LDH in direct care or purchased care during the 9-year study period. One-year surgery rates were 10.1% in beneficiaries who were diagnosed in direct care versus 11.3% in beneficiaries who were diagnosed in purchased care. Among the 7467 patients who were diagnosed in direct care and had surgery within 1 year, characteristics associated with lower probability of surgery in purchased care versus direct care included diagnosing facility type (hospital with a neurosurgery or spine specialty versus clinic (odds ratio [OR], 0.12 (95% CI, 0.10-0.15)), Navy versus Army (OR, 0.24 (95% CI, 0.21-0.28)), and diagnosing facility specialty (Medical Expense and Performance Reporting System) (surgical care (OR, 0.33 (95% CI, 0.27-0.40)) and orthopedic care (OR, 0.39 (95% CI, 0.33-0.46)) versus primary care. The presence of comorbidities was associated with higher probability of surgery in purchased care versus direct care (OR, 1.20 (95% CI, 1.06-1.36))., Conclusions: The 1-year rate of surgery for LDH was modestly higher in beneficiaries who were diagnosed in purchased care versus direct care. Among patients who were diagnosed in direct care, several patient-level and facility-level characteristics were associated with receiving surgery in purchased care, suggesting potentially unexpected variation in care utilization across components of the MHS., (© The Association of Military Surgeons of the United States 2023. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Patients with complex polytrauma in the military and civilian settings are often exposed to substantial diagnostic medical radiation because of serial imaging studies for injury diagnosis and subsequent management. This cumulative radiation exposure may increase the risk of subsequent malignancy. This is particularly true for combat-injured servicemembers who receive care at a variety of facilities worldwide. Currently, there is no coordinated effort to track the amount of radiation exposure each servicemember receives, nor a surveillance program to follow such patients in the long term. It is important to assess whether military servicemembers are exposed to excessive diagnostic radiation to mitigate or prevent such occurrences and monitor for carcinogenesis, when necessary. The cumulative amount of radiation exposure for combat-wounded and noncombat-wounded servicemembers has not been described, and it remains unknown whether diagnostic radiation exposure meets thresholds for an increased risk of carcinogenesis., Questions/purposes: We performed this study to (1) quantify the amount of exposure for combat-wounded servicemembers based on medical imaging in the first year after injury and compare those exposures with noncombat-related trauma, and (2) determine whether the cumulative dose of radiation correlates to the Injury Severity Score (ISS) across the combat-wounded and noncombat-wounded population combined., Methods: We performed a retrospective study of servicemembers who sustained combat or noncombat trauma and were treated at Walter Reed National Military Medical Center from 2005 to 2018. We evaluated patients using the Department of Defense Trauma Registry. After consolidating redundant records, the dataset included 3812 unique servicemember encounters. Three percent (104 of 3812) were excluded because of missing radiation exposure data in the electronic medical record. The final cohort included 3708 servicemembers who had combat or noncombat injury trauma, with a mean age at the time of injury of 26 ± 6 years and a mean ISS of 18 ± 12. The most common combat trauma mechanisms of injury were blast (in 65% [2415 of 3708 patients]), followed by high-velocity gunshot wounds (in 22% [815 of 3708 patients]). We calculated the cumulative diagnostic radiation dose exposure at 1 year post-traumatic injury in patients with combat-related trauma and those with noncombat trauma. We did this by multiplying the number of imaging studies by the standardized effective radiation dose for each imaging study type. We then performed analysis of variance for four data subsets (battle combat trauma, nonbattle civilian trauma, high ISS, and high radiation exposure [> 50 mSv]) independently. To evaluate whether the total number of imaging studies, radiation exposure, and ISS values differed between battle-wounded and nonbattle-wounded patients, we performed a pairwise t-test., Results: The mean radiation exposure for combat-related injuries was 35 ± 26 mSv while the mean radiation exposure for noncombat-related injuries was 22 ± 33 mSv in the first year after injury. In the first year after trauma, 44% of patients (1626 of 3708) were exposed to high levels of radiation that were greater than 20 mSv, and 23% (840 of 3708) were exposed to very high levels of radiation that were greater than 50 mSv. Servicemembers with combat trauma-related injuries had eight more imaging studies than those who sustained noncombat injuries. Servicemembers with combat trauma injuries (35 ± 26 mSv) were exposed to more radiation (approximately 4 mSv) than patients treated for noncombat injuries (22 ± 33 mSv) (p = 0.01). We found that servicemembers with combat injuries had a higher ISS than servicemembers with noncombat trauma (p < 0.001). We found a positive correlation between radiation exposure and ISS for servicemembers. The positive relationship between radiation exposure and ISS held for combat trauma (r 2 = 0.24; p < 0.001), noncombat trauma (r 2 = 0.20; p < 0.001), servicemembers with a high ISS (r 2 = 0.10; p < 0.001), and servicemembers exposed to high doses of radiation (r 2 = 0.09; p < 0.001)., Conclusion: These data should be used during clinical decision-making and patient counseling at military treatment facilities and might provide guidance to the Defense Health Agency. These recommendations will help determine whether the benefits of further imaging outweigh the risk of carcinogenesis. If not, we need to develop interdisciplinary clinical practice guidelines to reduce or minimize radiation exposure. It is important for treating physicians to seriously weigh the risk and benefits of every imaging study ordered because each test does not come without a cumulative risk., Level of Evidence: Level III, therapeutic study., Competing Interests: Each author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request., (Copyright © 2022 by the Association of Bone and Joint Surgeons.)

The TimeFISH database provides the first public time-series dataset on reef fish assemblages in the southwestern Atlantic (SWA), comprising 15 years of data (2007-2022) based on standardized Underwater Visual Censuses (UVCs). The rocky reefs covered by our dataset are influenced by pronounced seasonal cycles of ocean temperatures with warm tropical waters from the Brazil Current in the summer (~27°C) and colder waters from the La Plata River Plume discharge and upwelling from the South Atlantic Central Water in the winter (~18°C). These oceanographic conditions characterize this area as the southernmost tropical-subtropical climatic transition zone in the Atlantic Ocean. As a result, reef fish assemblages are comprised of both tropical and subtropical species. All records included in TimeFISH were collected using UVCs, a nondestructive method that allows the estimation of fish species richness, abundance, and body size distributions. UVCs were performed through 40 m 2 belt transects by scuba diving in nine locations along the southern Brazilian coast (25-29°S). Four of these locations lie within the boundaries of the no-entry Arvoredo Marine Biological Reserve, where fishing and recreational activities are forbidden, and the remaining locations are unprotected from these activities. During each belt transect, a diver swam at a constant depth above and parallel to the reef, identifying fish species, counting the number of individuals, and estimating the total body length (Lt in cm) of all detected individuals. All fish individuals in the water column (up to 2 m above the substratum) and at the bottom were targeted. In total, 202,965 individuals belonging to 163 reef fish species and 53 families were recorded across 1857 UVCs. All survey campaigns were funded by either public or mixed capital (private-public) sources, including seven grants from the Brazilian federal and Santa Catarina state governments. Part of the data has already been used in multiple MS.c. and Ph.D. theses and scientific articles. TimeFISH represents an important contribution for future studies aiming to examine temporal and spatial variations of reef fish assemblages in transition zones. No copyright restrictions apply to the use of this data set, other than citing this publication., (© 2022 The Ecological Society of America.)

Case: We present a 27-year-old man who presented with worsened back pain after a fall from a ladder. Unrelenting pain prompted the discovery through imaging and biopsy of a large pelvic plasmacytoma along with innumerable axial and appendicular lytic osseous lesions. The patient was soon thereafter diagnosed with light chain multiple myeloma (MM) and underwent measurable residual disease response-adapted consolidation treatment., Conclusion: The typical age at diagnosis for MM is 60 to 70 years. This case emphasizes the need to consider MM when diagnosing patients younger than 30 years, especially those with numerous bony lesions., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSCC/C29). Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, and patent/licensing arrangements) that might pose a conflict of interest in connection with the submitted article. The contents of this publication are the sole responsibility of the author(s) and do not necessarily reflect the views, opinions, or policies of Uniformed Services University of the Health Sciences (USUHS), the Department of Defense (DoD), or the Departments of the Army, Navy, or Air Force. Mention of trade names, commercial products, or organizations does not imply endorsement by the US government., (Copyright © 2023 by The Journal of Bone and Joint Surgery, Incorporated.)

Competing Interests: All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request.

Orthopaedic surgery ranks among the least racially and gender diverse medical/surgical specialties. United States military surgeons train in military or military-funded residency positions to care for a markedly diverse population; however, the composition and diversity of these training programs have not been previously assessed. The purpose of this study was to analyze the trends of physician diversity in military orthopaedics in comparison with other surgical specialties over time., Methods: We performed a retrospective cohort study evaluating matriculation into first year of residency training in US military surgical training programs between 2002 and 2020. In total, 9,124 applicants were reviewed. We collected matriculant self-reported race/ethnicity and sex and the medical/specialty program. We considered under-represented minorities as those who reported their race as African American, Indian/Alaskan Native, and Native, other, or who reported ethnicity as Hispanic. We calculated changes in persons accepted to training positions over time and used linear regression to model trends in diversity among orthopaedic matriculating residents when compared with other surgical subspecialities over time., Results: Across all surgical subspecialities, the average change in percent women was 0.94% per year for the study period (p < 0.01). The average annual percent women entering orthopaedic surgery residency programs was 14% for the 18-year study period. Across all surgical subspecialties, the average change for accepted applicants from groups underrepresented in medicine ( URiM ) was 1.01% per year for the study period (p < 0.01). The average annual percent URiM entering orthopaedic surgery residency programs was 17% for the 18-year study period. The annual change of women and URiM entering military orthopaedic residencies was 0.10% and 1.52%, respectively., Conclusions: Despite statistically significant improvements, recruitment efforts as used to date fall far short of reversing sexual, racial, and ethnic disparities in military orthopaedic residencies. Orthopaedics has a lower representation of both women and physicians with minority backgrounds when compared with many surgical subspecialties. Additional interventions are still necessary to increase diversity for military orthopaedic surgeons., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSOA/A454)., (Written work prepared by employees of the Federal Government as part of their official duties is, under the U.S. Copyright Act, a “work of the United States Government” for which copyright protection under Title 17 of the United States Code is not available. As such, copyright does not extend to the contributions of employees of the Federal Government.)

Anterior cruciate ligament (ACL) tears with concomitant cartilage injuries resulting in ACL reconstruction (ACLR) with cartilaginous procedures are common in the young, high-demand population. The purpose of this study was to report and characterize cartilage treatments performed at the time of index ACLR reconstruction and to determine if those treatments are associated with revision surgery (of any kind) in the 4-year follow-up. We performed a consecutive series of active duty service members in the Military Health System Data Repository with ACLR with and without concomitant cartilage procedures done at military facilities between October 2008 and September 2011. Patients were continuously enrolled with no history of knee surgeries for 2 years prior to primary ACLR. ACLR failure was defined as revision ACLR within 4 years following the primary ACLR. Of the 2,735 primary ACLRs included in the study, 5.3% (143/2,735) underwent isolated ACLR with a cartilage procedure. Of these patients, 23.07% (33/143) experienced ACLR failure within 4 years after ACLR with cartilage procedures, including 33.33% (11/33) undergoing revision ACLR. We found concomitant cartilage procedures at time of index ACLR to have the following rates of revision 35.59% (21/59) for microfracture, 14.63% (6/41) for chondroplasty, and 13.95% (6/43) for osteochondral grafts. The overall clinical failure rate of service members with ACLR plus concomitant cartilage procedure is 23.07% with minimum 4-year follow-up. Further research should be done to identify modifiable demographic and surgical factors associated with failure. This is a retrospective case-control study that reflects level of evidence III., Competing Interests: None declared., (Thieme. All rights reserved.)

Introduction: Patient-reported outcomes (PROs) are reporting tools that quantify patients' perceptions of their mental and physical health. Many PROs may inadvertently measure the same or overlapping theoretical constructs (e.g., pain, function, depression, etc.), which is both inefficient and a patient burden. The purpose of this study was to examine the functional relationship of the Single Assessment Numeric Evaluation (SANE) score and general constructs measured with the NIH Patient-Reported Outcomes Measurement Information System (PROMIS) in young patients undergoing shoulder surgery., Material and Methods: This study was an institutional review board approved retrospective case control of the Military Orthopaedics Tracking Injuries and Outcomes Network using 805 patients and 1,373 observations. All patients underwent shoulder surgery and had multiple observations ranging from 28 days pre-surgery to 428 days post-surgery. Correlation matrices and exploratory factor analysis were used to examine how each of the measured variables (PROMIS physical function, PROMIS pain interference, PROMIS sleep disturbance, PROMIS anxiety, PROMIS depression, and SANE surveys) contribute or "weigh" on latent factors, which are then mapped to a theoretical construct. This statistical method helps uncover structural relationships between measured variables., Results: The PROMIS and SANE surveys collectively weigh on two latent factors: psychological health (measured variables: PROMIS anxiety [0.95] and PROMIS depression [0.86]) and physical capabilities (measured variables: PROMIS physical function [0.81], PROMIS pain interference [-0.82], PROMIS sleep disturbance [-0.51], and SANE [0.68]). Although the physical capability construct is functionally related to psychological health (-0.45), there is no direct relation between SANE and measures of depression or anxiety., Conclusions: This study supports the use of the SANE as a valid single question to assess physical function providing similar information to the PROMIS in regard to measuring physical capabilities. Its simplicity makes it easy to use and implement with minimal uplift or change in workflow., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2021. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

The red porgy (Pagrus pagrus) is a carnivore bottom dweller sparid, inhabiting flat sandy bottoms, rhodolith and seagrass beds of the Mediterranean Sea, the Western Atlantic (from Florida to Argentina) and the Eastern Atlantic (from Britain to Gabon). Along its native range, the red porgy is highly targeted by commercial and artisanal fisheries. In the past 40 years, the population decline of the species has been widely reported. In many locations, such as the Brazilian coast, stocks have collapsed. The central portion of the Brazilian coast harbours the largest rhodolith beds in the world and the highest levels of nektonic and benthic biodiversity. Along the rhodolith megahabitat, P. pagrus density is disproportionately higher (by 480%) than that of conspicuous benthic fishes inhabiting the same environment. Despite the ecological and economic importance of such an important species along its native range, little is known regarding its habitat use, niche availability and population responses to global warming. Here we present habitat affinities based on data sampled using baited remote stereo-video systems, and modelled niche availability and global warming populational responses. Our findings reveal that the red porgy is a species highly associated with rhodolith beds along the central portion of the Brazilian coast. The presence of a disproportional density and biomass of the red porgy, compared to other marine fish species, indicates that the species plays a key ecological role as a carnivore, mesoconsumer and prey/predator tolerant species, maintaining essential ecological functions in the habitat. In a global warming scenario, the model predicted populational niche shifts poleward and a severe niche erosion at lower latitudes as expected. Conservation initiatives (implementation of Maine Protected Areas, trawling exclusion zones, mining exclusion zones, fisheries management policies) are urgent to secure future stocks of the red porgy and also preserve the fragile rhodolith beds they inhabit., (© 2022 Fisheries Society of the British Isles.)

Introduction: The US Military Health System (MHS) provides universal health care to beneficiaries. Few studies have evaluated the potential influence of access to universal care on survival outcomes for sarcoma. This study compared the survival of adult patients with soft-tissue sarcoma in the MHS with the US general population., Methods: MHS data were obtained from the Department of Defense Automated Central Tumor Registry (ACTUR). US population data were obtained from the National Cancer Institute's Surveillance, Epidemiology, and End Results registry. Patients who were 25 years or older with a histologically confirmed musculoskeletal soft-tissue sarcoma were matched based on age, sex, and race. Kaplan-Meier survival curves and Cox proportional hazards models were used to compare 5-year survival in the two groups., Results: Adult patients in ACTUR had markedly lower 5-year mortality for soft-tissue sarcomas (hazard ratio=0.82; 95% confidence interval, 0.73 to 0.92) after adjustment for potential confounders. Lower 5-year mortality was found in most demographic subgroups for ACTUR patients compared with Surveillance, Epidemiology, and End Results patients., Conclusion: Five-year survival in the MHS compared with the US general population may suggest an important role of universal health care in improving the survival of patients with soft-tissue sarcoma., Competing Interests: Each author certifies that he or she has no commercial associations (e.g. consultancies, stock ownership, equity interest, and patent/licensing arrangements) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request., (Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Orthopaedic Surgeons.)

Background: Prognostic indicators, treatments, and survival estimates vary by cancer type. Therefore, disease-specific models are needed to estimate patient survival. Our primary aim was to develop models to estimate survival duration after treatment for skeletal-related events (SREs) (symptomatic bone metastasis, including impending or actual pathologic fractures) in men with metastatic bone disease due to prostate cancer. Such disease-specific models could be added to the PATHFx clinical-decision support tool, which is available worldwide, free of charge. Our secondary aim was to determine disease-specific factors that should be included in an international cancer registry., Methods: We analyzed records of 438 men with metastatic prostate cancer who sustained SREs that required treatment with radiotherapy or surgery from 1989-2017. We developed and validated 6 models for 1-, 2-, 3-, 4-, 5-, and 10-year survival after treatment. Model performance was evaluated using calibration analysis, Brier scores, area under the receiver operator characteristic curve (AUC), and decision curve analysis to determine the models' clinical utility. We characterized the magnitude and direction of model features., Results: The models exhibited acceptable calibration, accuracy (Brier scores < 0.20), and classification ability (AUCs > 0.73). Decision curve analysis determined that all 6 models were suitable for clinical use. The order of feature importance was distinct for each model. In all models, 3 factors were positively associated with survival duration: younger age at metastasis diagnosis, proximal prostate-specific antigen (PSA) < 10 ng/mL, and slow-rising alkaline phosphatase velocity (APV)., Conclusions: We developed models that estimate survival duration in patients with metastatic bone disease due to prostate cancer. These models require external validation but should meanwhile be included in the PATHFx tool. PSA and APV data should be recorded in an international cancer registry., (© 2022. The Author(s).)

Purpose: To develop a machine-learning algorithm and clinician-friendly tool predicting the likelihood of prolonged opioid use (>90 days) following hip arthroscopy., Methods: The Military Data Repository was queried for all adult patients undergoing arthroscopic hip surgery between 2012 and 2017. Demographic, health history, and prescription records were extracted for all included patients. Opioid use was divided into preoperative use (30-365 days before surgery), perioperative use (30 days before surgery through 14 days after surgery), postoperative use (14-90 days after surgery), and prolonged postoperative use (90-365 days after surgery). Six machine-learning algorithms (Naïve Bayes, Gradient Boosting Machine, Extreme Gradient Boosting, Random Forest, Elastic Net Regularization, and artificial neural network) were developed. Area under the receiver operating curve and Brier scores were calculated for each model. Decision curve analysis was applied to assess clinical utility. Local-Interpretable Model-Agnostic Explanations were used to demonstrate factor weights within the selected model., Results: A total of 6,760 patients were included, of whom 2,762 (40.9%) filled at least 1 opioid prescription >90 days after surgery. The artificial neural network model showed superior discrimination and calibration with area under the receiver operating curve = 0.71 (95% confidence interval 0.68-0.74) and Brier score = 0.21 (95% confidence interval 0.20-0.22). Postsurgical opioid use, age, and preoperative opioid use had the most influence on model outcome. Lesser factors included the presence of a psychological comorbidity and strong history of a substance use disorder., Conclusions: The artificial neural network model shows sufficient validity and discrimination for use in clinical practice. The 5 identified factors (age, preoperative opioid use, postoperative opioid use, presence of a mental health comorbidity, and presence of a preoperative substance use disorder) accurately predict the likelihood of prolonged opioid use following hip arthroscopy., Level of Evidence: III, retrospective comparative prognostic trial., (Published by Elsevier Inc.)

Introduction: Established in 2009, the Department of Defense (DoD) Peer-Reviewed Orthopaedic Research Program (PRORP) is an annual funding program for orthopaedic research that seeks to develop evidence for new clinical practice guidelines, procedures, technologies, and drugs. The aim was to help reduce the burden of injury for wounded Service members, Veterans, and civilians and to increase return-to-duty and return-to-work rates. Relative to its burden of disease, musculoskeletal injuries (MSKIs) are one of the most disproportionately underfunded conditions. The focus of the PRORP includes a broad spectrum of MSKI in areas related to unique aspect of combat- and some noncombat-related injuries. The PRORP may serve as an important avenue of research for nonmilitary communities by offering areas of shared interests for the advancement of military and civilian patient cohort MSKI care. The purpose of this study was to provide a descriptive analysis of the DoD PRORP, which is an underrecognized but high value source of research funding for a broad spectrum of both combat- and noncombat-related MSKIs., Methods: The complete PRORP Funding Portfolio for FY2009-FY2017 was obtained from the Congressionally Directed Medical Research Programs (CDMRP), which includes 255 awarded grants. Information pulled from the CDMRP included awardee descriptors (sex, education level, affiliated institution type, research specialty, and previous award winner [yes/no]) and grant award descriptors (grant amount, year, primary and secondary awarded topics, research type awarded, and mechanism of award). Distribution statistics were broken down by principal investigator specialty, sex, degree, organization type, research type, mechanism, and research topics. Distribution and statistical analysis was applied using R software version 3.6.3., Results: From FY2009 to 2017, $285 million was allocated for 255 PRORP-funded research studies. The seven major orthopaedic subspecialties (foot and ankle, hand, musculoskeletal oncology, pediatrics, spine, sports medicine, and trauma) were represented. Trauma and hand subspecialists received the largest amount of funding, approximately $28 (9.6%) and $22 million (7.1%), respectively. However, only 22 (8.6%) and 26 (10.2%) of the primary investigators were trauma and hand subspecialists, respectively. The primary research categories were diverse with the top five funded PRORP topics being rehabilitation ($53 million), consortia ($39 million), surgery ($37 million), device development ($30 million), and pharmacology ($10 million)., Discussion: The CDMRP funding represents an excellent resource for orthopaedic medical research support that includes trauma and nontrauma orthopaedic conditions. This study serves to promote and communicate the missions of the PRORP both within and beyond the DoD to raise awareness and expand access of available funding for orthopaedic focused research., Significance/clinical Relevance: A likelihood exists that this project will provide sustained and powerful influence on future research by promoting awareness of orthopaedic funding sources., Level of Evidence: Level III., (Copyright © 2021 by the American Academy of Orthopaedic Surgeons.)

Brazilian endemic batoid elasmobranch populations have declined dramatically in the past 40 years due to anthropic activities (e.g., overfishing). The Brazilian guitarfish, Pseudobatos horkelii, included in the IUCN red list of endangered species [Critically Endangered (CR)], has been captured as by-catch by trawling fishing boats to the edge of extinction. Despite governmental conservation initiatives, the species is still caught and commercialized along the Brazilian coast. In this study, the authors report three rare aggregation events for the Brazilian coast of P. horkelii, inside the only nearshore no-entry Brazilian marine protected area. Strategies for its protection are also discussed., (© 2021 Fisheries Society of the British Isles.)

Background: We sought to compare survival outcomes of sarcomas in the pediatric and adolescent/young adult populations with universal care access in the Military Health System (MHS) to those from the United States general population., Methods: We compared data from the Department of Defense's (DoD) Automated Central Tumor Registry (ACTUR) and the National Cancer Institute's (NCI) Surveillance, Epidemiology, and End Results (SEER) program on the overall survival of patients 24 years or younger with histologically or microscopically confirmed sarcoma between diagnosed between January 1, 1987, and December 31, 2013. The Kaplan-Meier survival curves were used to compare survival between the 2 patient populations. Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) comparing ACTUR relative to SEER., Results: The final analysis included 309 and 1236 bone sarcoma cases and 465 and 1860 soft tissue sarcoma cases from ACTUR and SEER, respectively. Cox proportional hazards analysis showed soft tissue sarcoma patients in ACTUR had significantly better overall (HR=0.73, 95% CI=0.55-0.98) and 5-year overall (HR=0.63, 95% CI=0.46-0.86) survival compared with SEER patients, but no significant difference in overall or 5-year overall survival between ACTUR and SEER patients with bone sarcoma., Conclusion: Survival data from the ACTUR database demonstrated significantly improved overall survival for soft tissue sarcomas and equivalent survival in bone sarcomas compared with that reported by SEER., Competing Interests: The authors declare no conflict of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

The menisci are fibrocartilaginous semilunar structures in the knee that provide load support. Injury to the meniscus alters its load sharing and biomechanical profile. Knee arthroscopy with meniscus débridement is the most common orthopaedic surgical procedure done in the United States. The current goals of meniscal surgery are to preserve native meniscal tissue and maintain structural integrity. Meniscal preservation is critical to maintain the normal mechanics and homeostasis of the knee; however, it is not always feasible because of the structure's poor blood supply and often requires removal of irreparable tissue with meniscectomy. Efforts have increasingly focused on the promotion of meniscal healing and the replacement of damaged menisci with allografts, scaffolds, meniscal implants, or substitutes. The purpose of this article was to review current and future meniscal salvage treatments such as meniscus transplant, synthetic arthroplasty, and possible bioprinted meniscus to allow patients to maintain quality of life, limit pain, and delay osteoarthritis., (Copyright © 2021 by the American Academy of Orthopaedic Surgeons.)

Ocean warming and acidification can cause deleterious effects on marine biota, which may be potentialized when associated with metal pollution. Thus, the aim of this work was to evaluate the effects of pH decrease, temperature increase and lead contamination on fertility rate and embryo-larval development of Echinometra lucunter. Gametes and embryos were exposed at pH 8.2 (control) and 7.5; at 26°C (control) and 28°C; and at lead concentrations of 0 (control), 125, 250 and 500 μg/L. These conditions were tested individually and in combination. The fertilization rate of E. lucunter was only significantly reduced in the treatments where temperature was increased and in the treatment where pH decreased. However, the development rate of the pluteus larvae was significantly affected in the majority of treatments: metal contamination in the higher concentration; decreased pH in all metal concentrations; increased temperature in the highest metal concentration; decreased pH and increased temperature and all variables combined, which is decreased pH, increased temperature and metal contamination in relation to the control group (C). The development test was shown to be more sensitive than the fertilization test in all the studied scenarios. In general, the present study suggests that pH decrease, temperature increase and metal pollution may have a significant impact on E. lucunter reproductive cycle.

Background  Scaphoid nonunion can lead to carpal collapse and osteoarthritis, a painfully debilitating problem. Bone morphogenetic protein (BMP) has been successfully implemented to augment bone healing in other circumstances, but its use in scaphoid nonunion has yielded conflicting results. Case Description  The purpose of this study is to assess the outcomes and complications of scaphoid nonunion treated surgically with BMP. Literature Review  A literature review of all available journal articles citing the use of BMP in scaphoid nonunion surgery from 2002 to 2019 was conducted. We included studies that used BMP as an adjunct to surgical treatment for scaphoid nonunions in both the primary and revision settings with computed tomography determination of union. Demographic information, dose of BMP, tobacco use, outcomes, and complications were recorded. A total of 21 cases were included from four different studies meeting inclusion criteria. Clinical Relevance  The union rates were 90.5% overall, 100% for primary surgeries, and 77.8% for revision surgeries. Five patients (24%) experienced 11 complications, including four cases (19%) of heterotrophic ossification. Use of BMP in scaphoid nonunion surgery resulted in a 90.5% overall union rate but was also associated with complications such as heterotopic ossification. All included studies used BMP to augment bone graft, screw or wire fixation, or a combination of methods. The efficacy of BMP in scaphoid nonunion is unclear, and a sufficiently powered, randomized controlled trial is needed to determine optimal fixation methods, dosing, and morbidity of the use of BMP. Level of Evidence  This is a Level IC, therapeutic interventional study., Competing Interests: Conflict of Interest None declared., (Thieme. All rights reserved.)

Kelps are canopy-forming brown seaweed sustaining critical ecosystem services in coastal habitats, including shelter, nursery grounds, and providing food resources to a myriad of associated species. This study modeled the fundamental niche of Laminaria abyssalis along the Brazilian continental margin, an endemic species of the South Atlantic, to anticipate potential distributional range shifts under two contrasting scenarios of future environmental changes (RCP2.6 and RCP8.5). The model for fundamental niche predictions considering the "present scenario" has shown a wider potential area than the realized niche (i.e., the area where the species actually occurs) along the Brazilian coast. In both future scenarios, the models have shown niche erosion on the northern portion of the Brazilian coast and niche gains towards the south. In both scenarios, L. abyssalis populations tend to shift to deeper regions of the reef. The restricted range of occurrence (33,000 km 2 ), intense anthropic activities along these beds (e.g., trawling fisheries, oil/gas mining, or removal for agricultural purposes) acting synergically with global warming, may drive this ecosystem to collapse faster than kelp species' ability to adapt. We propose to classify L. abyssalis as Endangered - (EN) under IUCN criteria, and highlight that long-term monitoring of kelp beds is an urgent need to develop effective conservation initiatives to protect such rare and invaluable ecosystem., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Distal radius fractures are one of the most common orthopedic injuries. After history, physical examination, and diagnostic imaging, treatment begins with closed reduction and immobilization to restore an upper extremity that has both acceptable alignment and stability. Whether for definitive nonoperative management or in preparation for surgical fixation, it is important to understand the principles of closed reduction and immobilization. This article presents a brief review of indications and a technical guide to successful closed reduction and casting for the orthopedic surgeon., Competing Interests: Disclosure The views expressed are those of the author and do not reflect the official policy of the Department of the Army/Navy/Air Force, Department of Defense, or US Government., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Study Design: Retrospective cohort., Objective: To determine surgery-free survival of patients receiving conservative management of lumbar disc herniation (LDH) in the military healthcare system (MHS) and risk factors for surgical intervention., Summary of Background Data: Radiculopathy from LDH is a major cause of morbidity and cost., Methods: The Military Data Repository was queried for all patients diagnosed with LDH from FY2011-2018; the earliest such diagnosis in a military treatment facility (MTF) was kept for each patient as the initial diagnosis. Follow-up time to surgical intervention was defined as the time from diagnosis to first encounter for lumbar microdiscectomy or lumbar decompression in either a MTF or in the civilian sector. The Military Data Repository was also queried for history of tobacco use at any time during MHS care, age at the time of diagnosis, sex, MHS beneficiary category, and diagnosing facility characteristics. Multivariable Cox proportional hazards models were used to evaluate the associations of patient and diagnosing facility characteristics with time to surgical intervention., Results: A total of 84,985 MHS beneficiaries including 62,771 active duty service members were diagnosed with LDH in a MTF during the 8-year study period. A total of 10,532 (12.4%) MHS beneficiaries, including 7650 (10.9%) active duty, failed conservative management onto surgical intervention with lumbar microdiscectomy or lumbar decompression. Median follow-up time of the cohort was 5.2 (interquartile range 2.6, 7.5) years. Among all healthcare beneficiaries, several patient-level (younger age, male sex, and history of tobacco use) and facility-level characteristics (hospital vs. clinic and surgical care vs. primary care clinic) were independently associated with higher risk of surgical intervention., Conclusion: LDH compromises military readiness and negatively impacts healthcare costs. MHS beneficiaries with LDH have a good prognosis with approximately 88% of patients successfully completing conservative management. However, strategies to improve outcomes of conservative management in LDH should address risks associated with both patient and facility characteristics.Level of Evidence: 4., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)